PUBLICHEALTHMATTERS Winter 2014-2015
IPHA History Smoking and Health - Fifty Years Later
By Dr. Ronald Eckoff
Dr. J.J. Kellogg says: “A few months ago I had all the nicotine removed from a cigarette, making a solution
out of it. I injected half the quantity into a frog, with the effect that the frog died almost instantly. The
rest was administered to another frog with like effect. Both frogs were full grown, and of average size. The
conclusion is evident that a single cigarette contains poison enough to kill two frogs. A boy who smokes
twenty cigarettes a day has inhaled enough poison to kill forty frogs. Why does the poison not kill the boy?
It does kill him. If not immediately, he will die sooner or later of a weak heart, Bright’s disease, or some
other malady which scientific physicians everywhere now recognize as a natural result of chronic nicotine
poisoning.” Thirteenth Biennial Report of the Iowa State Board of Health – 1906
In 1964 Public Health Service Publication No. 1103 titled,
“Smoking and Health: Report of the Advisory Committee to
the Surgeon of the Public Health Service” was released. (I
always thought it was the Surgeon General’s Report, but it was a
report to the Surgeon General.) The committee reviewed over
6,000 papers.
!
The report is almost 400 pages and has great detail on many
aspects. The report also briefly covers history from the 16th
century to the present. “In the early part of the 16th century,
soon after the introduction of tobacco into Spain and England
by explorers returning from the New World, controversy
developed from differing opinions as to the effects of the human
use of the leaf and products derived from it by combustion or
other means. Pipe-smoking, chewing, and snuffing of tobacco
were praised for pleasurable and reputed medicinal actions. At
the same time, smoking was condemned as a foul-smelling,
loathsome custom, harmful to the brain and lungs.”
!
The committee was very cautious in reaching conclusions. They
required strong evidence. A few of the major conclusions:
• Cigarette smoking is associated with a 70 percent increase in
the age-specific death rates of males.
• Cigarette smoking is causally related to lung cancer in men:
the magnitude of the effect of cigarette smoking far outweighs
all other factors. The data for women, though less extensive,
point in the same direction.
• Cigarette smoking is the most important of the causes of
chronic bronchitis in the United States, and increases the risk
of dying from chronic bronchitis and emphysema.
• It is established that male cigarette smokers have a higher
death rate from coronary artery disease than non-smoking
males. Although the causative role of cigarette smoking in
deaths from coronary disease is not proven, the Committee
considers it more prudent from a public health viewpoint to
assume that the established association has a causative
meaning than to suspend judgment until no uncertainty
remains.
• Pipe smoking appears to be causally related to lip cancer.
• Women who smoke cigarettes during pregnancy tend to have
babies of lower birth weight.
• Smoking is associated with accidental deaths from fires in the
home.
What happened after the report came out?
At the Iowa Public Health Association Annual Meeting on May
8, 1964, Dr. Addison Brown of Des Moines, President of the
Iowa Division of the American Cancer Society presented
“Cigarette Smoking and Health.”
!
I came to Iowa in the Heart Disease Control Program of the US
Public Health Service in 1965 and worked in heart disease,
cancer and chronic illness (three categorical federal funding
programs). We started antismoking activities, but it was hard to
see any impact for the first fifteen years. We contracted with a
man who had had his larynx removed due to cancer to do school
presentations. At the 1966 Iowa State Fair I filled wheelbarrow
with cigarette butts for the display. I had read that a pack a day
smoker would produce enough cigarette butts to fill a certain
size wheelbarrow. It was pretty easy to collect the cigarette butts,
since ash trays were everywhere in the Lucas Building. We did a
simple lung function test in conjunction with the wheelbarrow
display.
!
The voluntary health agencies were also doing activities to try to
reduce smoking. However I remember going to Cancer Society
meetings and a significant number of people would smoke
during the meetings. Smoking was common at the lunch or
banquet of the Iowa Public Health Association. I particularly
remember an IPHA luncheon speaker in the 1970s getting up
and flossing his teeth before speaking. He said his wife told him
it wasn’t polite to do that in public, but he said it was a healthy
activity. People in the audience were doing an unhealthy activity,
smoking, which was socially acceptable.
!
Sometime in the late 1970s or possibly the early 1980s, sorry I
don’t know the date, smoking was banned in the Iowa
Department of Public Health offices and meeting rooms. This
was well before smoking was banned in most public places.
!
I know we are sometimes discouraged by the slow progress and
new challenges regarding tobacco and e-cigarettes. But smoking
was so ingrained in society (look at an old movie) that I think
looking forward from 1964 it would have been hard to imagine
we would have made as much progress as we have. We should
celebrate the progress. Then we should dream about what might
be accomplished in the next fifty years.
Click here to view the 2014 Report of the Surgeon General “The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon
General, 2014"
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